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Health Policy. 2006 Mar;76(1):72-9. Epub 2005 Jul 1.

Direct access in primary care and patient satisfaction: a European study.

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  • 1NIVEL (Netherlands Institute of Health Services Research), P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.



This study addressed the question to what extent gate-keeping or direct access to health care services influences the satisfaction with GP-services by the population in 18 European countries ("old" EU-countries plus Norway, Iceland and Switzerland).


Two datasets were collected. Firstly, country experts were asked to indicate for 17 different health care providers whether they were directly accessible. A direct accessibility scale was computed from the percentage of services that were directly accessible. Secondly, for patient satisfaction the EUROPEP study was used. This dataset contained information about patient satisfaction with general practitioners services in 14 European countries.


If more health care providers were directly accessible in a country, patients showed a higher satisfaction with general practice than in countries where more referrals were required (Pearson's r = 0.54, p = 0.05). Satisfaction with organisational aspects of general practice (concerning amongst others waiting time and possibilities to make appointments) correlates significantly with a high score on our direct accessibility measure (Pearson's r = 0.67, p = 0.01). Satisfaction with patient physician communication (Pearson's r = 0.46, p = 0.10) and medical technical content of the care (Pearson's r = 0.41, p = 0.14) are not influenced by direct accessibility.


Direct accessibility appeared to be important for patients. Apparently, if patients have freedom of choice for the type of health care provider, they evaluate the GP-services more positively. However, this mainly concerns satisfaction with organisational aspects of GP-services; the accessibility does not influence patient's judgement about the actual care provided by their GP.

[PubMed - indexed for MEDLINE]
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